Satisfaction In Total Knee Arthroplasty Research Articles

One-Year Postoperative Patient-Reported Outcome Measures Are Associated With Three-Year to Five-Year Postoperative Satisfaction in Total Knee Arthroplasty

BackgroundOver the past couple of decades, the definition of success after total knee arthroplasty (TKA) has shifted away from clinician-rated metrics and toward the patient’s subjective experience. Therefore, understanding the aspects of patient recovery that drive 3-year to 5-year satisfaction after TKA is crucial. The aims of this study were to (1) determine the 1-year postoperative factors, specifically patient-reported outcome measures (PROMs) that were associated with 3-year and 5-year postoperative satisfaction and (2) understand the factors that drive those who are not satisfied at 1 year postoperatively to become satisfied later in the postoperative course. MethodsThis was a retrospective study of 402 TKA patients who were gathered prospectively and presented for their 1-year follow-up. Demographics were collected preoperatively and patient-reported outcomes were collected at 1, 3, and 5 years postoperatively. Logistic regressions were used to identify the factors at 1 year that were associated with 3-year and 5-year satisfaction. ResultsAssociations between 1-year PROMs with 3-year satisfaction were observed. Longer term satisfaction at 5 years was more closely associated with EuroQol 5 Dimension Mobility, Activity Score, and Numerical Rating Scale Satisfaction. Of those who were not satisfied at 1 year, EuroQol 5 Dimension Mobility, Knee Disability Osteoarthritis Outcome Score Function in Sport and Recreation, and Satisfaction were associated with becoming satisfied at 3 years. ConclusionThe 1-year PROMs were found to be associated with satisfaction at 3 to 5 years after TKA. Importantly, many of the PROMs that were associated with 3-year to 5-year satisfaction, especially in those who were not originally satisfied at 1 year, were focused on mobility and activity level.

The influence of obesity on functional outcomes and patient satisfaction 8 weeks after total knee arthroplasty: results of the prospective FInGK study

ObjectivesTo investigate obese versus non-obese subjects´ knee joint function, stiffness, pain, expectations, and outcome satisfaction before and two months after total knee arthroplasty (TKA).MethodsThis study is a secondary analysis of data retrieved via a prospective single-centre cohort study investigating knee joint function and health care services utilization in patients undergoing TKA (FInGK Study). For the primary study, elective TKA patients were consecutively recruited between December 2019 and May 2021. Preoperative expectations, Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), surgery outcome satisfaction, and sociodemographic variables were assessed via self-reported questionnaires. In the current study, obese (Body Mass Index (BMI) ≥ 30 kg/m²) versus non-obese (BMI < 30 kg/m²) subjects’ data were exploratively compared before and two months after TKA. Multivariable logistic regression assessed factors associated with TKA satisfaction two months postoperatively. Linear regression evaluated factors associated with higher WOMAC change two months postoperatively.ResultsA total of 241 subjects participated (response: 85.2%). Eighty-seven were non-obese (mean age: 70.7 years, 63.2% female) and 154 were obese (mean age: 67.1 years, 57.8% female). Obese subjects reported inferior pre- and postoperative pain and knee joint function compared to non-obese subjects. Yet, WOMAC scores of obese and non-obese subjects significantly improved from preoperative means of 52.6 and 46.8 to 32.3 and 24.4 after surgery, respectively. The only significant TKA satisfaction predictor was subjects’ smoking status. Non-obesity and worse preoperative WOMAC scores were predictive of higher WOMAC change scores after two months.ConclusionBoth obese and non-obese subjects reported significant symptom improvements. However, as obese subjects’ short-term outcomes were still inferior, more research on TKA rehabilitation measures adapted to the needs of this growing patient group is warranted to maximize their benefits from TKA.

What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement

BackgroundGlobally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA results and efforts need to be made to improve these rates. This study set out to identify what patients consider important when reflecting on TKA satisfaction, to pave the way to identifying service transformation opportunities that will enhance patient-centred care and satisfaction with this procedure.MethodsTwenty-seven TKA recipients were recruited in the province of British Columbia, Canada. Semi-structured interviews were conducted about participants’ experience and satisfaction with TKA, three to four years post-surgery. Grounded theory was employed to analyze participants’ stories about what was front of mind when they reflected on satisfaction with their new knee.ResultsParticipants described their post-TKA knee in terms its adequacy: how it felt and worked, and how it matched their pre-surgical expectations. The central element of their stories was the process of adapting, which gave rise to their perceptions of adequacy. Adapting comprises the patient experience of physically integrating and cognitively accepting their new knee. Patterns of adapting reflect the level of the new knee’s achieved adequacy and the straightforwardness of the adapting process.DiscussionThe conceptualization of adequacy and the process of adapting allow a patient-centred understanding of what patients experience following TKA. For participants who did not readily achieve the adequacy they had anticipated, the challenges they experienced during adapting dominated their stories. Participants’ adapting stories afford key insights into how the health care system could adjust to better support TKA patients, and improve rates of satisfaction with this procedure.ConclusionsThe process of adapting lends itself to system intervention in support of enhanced post-TKA outcomes and satisfaction. These interventions could include the development of a care model including long-term clinical support for patients whose knees do not achieve desired results on schedule, and collaborating with patients to set and manage reasonable expectations about how their post-TKA knee will feel and function.

Criteria for Implant Fit Assessment in Total Knee Arthroplasty – A Review

Abstract Patient satisfaction in total knee arthroplasty is still limited and lower compared to patient satisfaction in total hip arthroplasty. While there are multiple influence factors for patient satisfaction, implant design is one aspect to consider. In clinical practice, the patient-specific assessment of implant fit is limited to a matching of the anteroposterior and mediolateral size, based on X-rays. Hence, the goal of this review was to identify other potential criteria for a patientspecific implant fit evaluation. A literature review was performed in PubMed. Inclusion criteria were a patientspecific assessment of knee implant components, a comprehensible motivation or a statistically proven relationship with an outcome measure, and a clear method description. Implant fit was considered not only as a matching of size, shape and interface, but also to include the implant’s (rotational) alignment, as proposed by Dai et al. (2014). Several studies reported a statistically significant relationship of implant fit criteria with outcome measures. Many more studies proposed fit criteria, motivated by a potential relationship with outcome measures. Most criteria assessed the bone-implant interface, second the morphology of the articulating surfaces and third the component and resulting bony alignment. Obstacles for the assessment of the criteria identified is the limited availability of 3D surface models in TKA. However, with new imaging technologies this availability is likely to increase. The decision process regarding the implant in TKA could be supported by a comprehensive automated fit analysis of several designs and/or sizes. An adequate matching of the implant to the respective patient may improve patient satisfaction.

Goals, challenges and strategies for wound and bleeding management in total knee arthroplasty: A modified Delphi method.

Surgical techniques related to soft tissue management play critical roles in optimizing surgical outcomes and patient satisfaction in total knee arthroplasty (TKA). Despite the importance of wound closure and bleeding management approaches, no published guidelines/consensus are available. Twelve orthopedic surgeons participated in a modified Delphi panel consisting of 2 parts (each part comprising two rounds) from September-October 2018. Questionnaires were developed based on published evidence and guidelines on surgical techniques/materials. Questionnaires were administered via email (Round 1) or at a face-to-face meeting (subsequent rounds). Panelists ranked their agreement with each statement on a five-point Likert scale. Consensus was achieved if ≥70% of panelists selected 4/5, or 1/2. Statements not reaching consensus in Round 1 were discussed and repeated or modified in Round 2. Statements not reaching consensus in Round 2 were excluded from the final consensus framework. Consensus was reached on 13 goals of wound management. Panelists agreed on 38 challenges and 71 strategies addressing surgical techniques or wound closure materials for each tissue layer, and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus. Consensus from Asia-Pacific TKA experts highlights the importance of wound management in optimizing TKA outcomes. The consensus framework provides a basis for future research, guidance to reduce variability in patient outcomes, and can help inform recommendations for wound management in TKA.

Does the anatomic design of total knee prosthesis allow for a better component fit than its nonanatomic predecessor? A matched cohort Study.

BackgroundTotal knee arthroplasty (TKA) is considered the most efficient treatment of end-stage osteoarthritis. There is an ongoing debate about proper implant designs and articulation types. One of the considered causes of unsatisfactory outcome and patients’ dissatisfaction is femoral or tibial component overhanging, which can lead to chronic knee pain and restricted motion. The aim of this study is to compare radiological outcomes of TKA using an anatomic PERSONA Posterior-Stabilized (PS) knee design with its nonanatomic predecessor, the NexGen LPS.MethodsA group of 39 patients who received the PERSONA PS system and 33 patients who received the NexGen LPS was included. PERSONA patients were matched to NexGen patients using a 0.1 propensity score threshold with priority given to exact matches. Anteroposterior, lateral, and long-leg radiographs were taken preoperatively and at 6 weeks postoperatively to perform radiological and statistical analysis.ResultsThe PERSONA subgroup had statistically higher posterior condylar offset. There is no statistically significant difference in posterior condylar offset ratio. There were less cases of femoral notching, femoral overhang, and placing tibial baseplate in the medial overhang in the PERSONA PS subgroup than in the NexGen subgroup (each statistically significant). Occurrence of tibial underhang was not statistically significant.ConclusionRadiological assessment in short-term follow-up showed excellent results for PERSONA knee design with better fit to native femur and tibia. In comparison to its predecessor, it also spares more bone tissue. As the aforementioned parameters are risk factors of lesser clinical outcomes, the PERSONA design gives high hopes for improvement of TKA satisfaction rate.

Patient expectations and satisfaction in robotic-assisted total knee arthroplasty: a prospective two-year outcome study.

The impact of fulfillment of patient expectations throughout recovery on satisfaction in total knee arthroplasty (TKA) is not well understood. Utilizing a standardized TKA method with a robotically assisted (RA) platform, we investigated the impact of expectation fulfillment at 3-month (M) and 6-M on 1-year (Y) and 2-Y satisfaction. We hypothesize that early fulfillment of patient expectations is associated with improved midterm patient satisfaction. We also compare improvements in outcomes with RA-TKA to those of a recent large national TKA cohort study to determine whether RA-TKA meets or exceeds the current standard of care. One hundred six patients were prospectively enrolled and underwent robotic-assisted TKA by a single surgeon using the OMNIBotics system. Patients completed KOOS and New Knee Society Score (KSS) preoperatively and at 3M, 6M, 1Y, and 2Y postoperatively. Expectation fulfillment was subdivided into patients who were below or above the average expectation score pre-operatively, or fulfillment of expectation score at 3M and 6M post TKA. The satisfaction of each group was then compared at 1Y and 2Y post TKA. Study cohort outcomes were compared to contemporary literature from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) database. Patients with greater than average KSS expectation fulfillment at 3M reported significantly higher KSS satisfaction scores at 1Y (34.9 ± 5.3 vs 30.6 ± 6.7, p = 0.0012), and patients with greater than average 6M expectation fulfillment reported improved satisfaction at 1Y (33.9 ± 5.9 vs 31.1 ± 6.7, p = 0.0330) and 2Y (35.2 ± 4.8 vs 32.4 ± 6.8, p = 0.0323). When compared to the FORCE-TJR database, no significant differences in post-operative KOOS outcomes were observed except for Sports and Recreation, for which the RAS group demonstrated higher scores (65.5 ± 30.0 vs 53.0 ± 27.1 p < 0.0001); however, the study cohort reported significantly greater improvements in KOOS Pain, Symptoms, Sports and Recreation, and Quality of Life at multiple time points up to 2years post TKA. High early-expectation fulfillment was associated with improved satisfaction at 1Y and 2Y, indicating the importance of managing patient-specific post-operative care to ensure patients reach their pre-operative goals. Greater improvements in all KOOS sub-scores and in absolute Sports and Recreation at 1Y and 2Y were observed in this robotic-assisted cohort compared to a large contemporary database, indicating that RAS meets or exceeds current standard of care benchmarks for patient-reported outcomes.

Musculoskeletal Health Literacy is Associated With Outcome and Satisfaction of Total Knee Arthroplasty

BackgroundThe purpose of this study was to investigate if there is an association between musculoskeletal health literacy with outcome and satisfaction after total knee arthroplasty (TKA). MethodsA cross-sectional study was performed at our tertiary center to include patients between one and six years postoperatively after primary TKA. Patients were provided a survey including basic demographics, validated musculoskeletal health literacy scale (Literacy in Musculoskeletal Problems), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and TKA satisfaction (whether they would choose to undergo the same operation again). Patients were categorized as either low or normal health literacy based on number of questions (cutoff 6 out of 9) answered correctly on the Literacy in Musculoskeletal Problems. Statistical analysis included multivariate regression with significance at P < .05. ResultsFour hundred fifty-three individuals fully completed the survey of eligible participants. Two hundred ninety-six individuals (65.3%) had normal health literacy, and one hundred fifty-seven individuals (34.7%) had low health literacy. Average WOMAC (/96) was 18.0 ± 19.7 in the low and 12.1 ± 15.4 in the normal health literacy groups. Patients with low health literacy had significantly higher WOMAC (worse function) than those with normal health literacy (P = .001). Patients with normal musculoskeletal health literacy were significantly more likely to undergo the same operation again (P = .01, odds ratio 2.163). ConclusionThis study shows that patients with low musculoskeletal health literacy have worse outcome scores and are less likely to be satisfied with their TKA. By identifying these patients preoperatively, emphasis can be placed on enhancing procedure expectations and understanding to improve outcome measures and overall satisfaction.

Early Identification of Patient Satisfaction Two Years After Total Knee Arthroplasty

BackgroundThere are numerous reports of poor satisfaction after total knee arthroplasty (TKA), yet there is little known about when to use evidence-based models of care to improve patient outcomes. ObjectiveThis study aimed to characterize longitudinal changes in patient-reported satisfaction after TKA and to identify factors for early identification of poor satisfaction. MethodsFor a cohort of primary TKA surgeries (n = 86), patient-reported outcomes were captured one week before TKA and 6 weeks, 12 weeks, 6 months, and 1 and 2 years after TKA. “Satisfied” versus “not fully satisfied” patients were defined using a binary response (≥90 vs <90) from a 100-point scale. Wilcoxon signed-rank tests identified changes in satisfaction between follow-up times, and longitudinal analyses examined demographic and questionnaire factors associated with satisfaction. ResultsImprovements in satisfaction occurred within the first 6 months after TKA (P ≤ 0.01). Preoperative patient-reported outcome measures alone were not predictive of satisfaction. Key factors that improved longitudinal satisfaction included higher Oxford Knee Scores (odds ratio (OR) = 2.1, P < .001), general health (EQ-VAS, OR = 1.3, P = .03), and less visual analog scale pain (VAS; OR = 1.7, P < .001). Differences in these factors between satisfied and not fully satisfied patients were identified as early as 6 weeks after surgery. ConclusionVisibly different satisfaction profiles were captured among satisfied and not fully satisfied patient responses, with differences in patient-perceived joint function, general health, and pain severity occurring as early as 6 weeks after surgery. This study provides metrics to support early identification of patients at risk of poor TKA satisfaction, enabling clinicians to apply timely targeted treatment and support interventions, with the aim of improving patient outcomes.

Can Met Expectations Moderate the Relationship Between Pain/Function and Satisfaction in Total Knee Arthroplasty?

BackgroundApproximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored. The primary aim of this study is to evaluate if met expectations moderate the relationship between pain and function variables and satisfaction. MethodsPatients who underwent primary TKA for osteoarthritis were included in the study (n = 304). Patient-reported outcomes at pre-surgery and 1-year post-surgery were collected. The Knee Society Score (KSS) satisfaction subscale was used as the dependent variable. Candidate independent variables included the following: demographics, KSS, Knee injury and Osteoarthritis Outcome Score (KOOS), 12-Item Short Form Health Survey (SF-12), Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Self-Administered Comorbidity Questionnaire, and University of California Los Angeles activity score. Separate linear regression models were created to test interactions for KSS met expectations with pain and KSS met expectations with function. ResultsSignificant predictors of satisfaction were KSS symptoms (pain), KOOS activities of daily living (function), KSS met expectations, KOOS pre-surgery activities of daily living, body mass index, and SF-12 general health. A significant interaction between met expectations and pain was found (P = .043) and the met expectations and function interaction approached significance (P = .086). For both interactions, as met expectations increased, pain and function predicted satisfaction less strongly. ConclusionMet expectations were found to moderate the relationship between pain and satisfaction. There may be more value in improving pain for patients with low met expectations. Level of evidenceLevel IV.

A Medial Congruent Polyethylene Offers Satisfactory Early Outcomes and Patient Satisfaction in Total Knee Arthroplasty.

BackgroundAlthough a successful operation, almost 20% of patients are dissatisfied with total knee arthroplasty (TKA). The purpose of this retrospective cohort study was to see if a medial congruent (MC) polyethylene would offer satisfactory early outcomes and patient satisfaction after TKA.MethodsWe reviewed prospectively collected data on 327 TKAs using multiple bearings within the same implant system. Ninety-six received an MC bearing, 70 received a cruciate-retaining (CR) bearing, and 161 received a posterior-stabilized (PS) bearing. We evaluated the visual analog scale pain scores and range of motion (ROM) at 2 weeks, 6 weeks, 3 months, and 1 year; Patient-Reported Outcomes Measurement Information System (PROMIS-10) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 3 months and 1 year; and Forgotten Joint Score (FJS-12) at 1 year.ResultsAll groups had similar KOOS and PROMIS-10 scores. MC knees had lower visual analog scale scores than PS knees at all time points (P < .05) and a higher ROM than PS at 2 weeks (98.6 vs 93.7, P = .002). MC knees had a significantly higher FJS-12 than CR knees (71.6 vs 58.7, P = .02). More MC knees were “very satisfied” than CR (92.6% vs 81.5%, P = .04). Fewer MC knees were “not at all satisfied” than CR (1.2% vs 9.2%, P = .04). There were similar satisfaction ratings with MC and PS.ConclusionsAn MC bearing provided similar or improved early pain, ROM, KOOS, PROMIS-10, FJS-12, and patient satisfaction as compared with standard bearings in TKA.

Patients' Preoperative Expectations of Total Knee Arthroplasty and Satisfaction With Outcomes at One Year: A Prospective Cohort Study.

To assess the relationship between patients' expectations for total knee arthroplasty (TKA) and satisfaction with surgical outcome. This prospective cohort study recruited patients with knee osteoarthritis (OA) ages ≥30 years who were referred for TKA at 2 hip/knee surgery centers in Alberta, Canada. Those who received primary, unilateral TKA completed questionnaires pre-TKA to assess TKA expectations (17-item Hospital for Special Surgery [HSS] TKA Expectations questionnaire) and contextual factors (age, sex, Western Ontario and McMaster Universities Osteoarthritis Index pain score, Knee Injury and Osteoarthritis Outcome Score physical function short form [KOOS-PS], 8-item Patient Health Questionnaire depression scale, body mass index [BMI], comorbidities, and prior joint replacement), and 1-year post-TKA to assess overall satisfaction with TKA results. Using multivariate logistic regression, we examined the relationship between TKA expectations (HSS TKA outcomes considered to be very important) and postoperative satisfaction (very satisfied versus somewhat satisfied versus dissatisfied). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. At 1 year, 1,266 patients with TKA (92.1%) reported their TKA satisfaction (mean ± SD age 67.2 ± 8.8 years, 60.9% women, and mean BMI 32.6 kg/m2 ); 74.7% of patients were very satisfied, 17.1% were somewhat satisfied, and 8.2% were dissatisfied. Controlling for other factors, an expectation of TKA to improve patients' ability to kneel was associated with lower odds of satisfaction (adjusted OR 0.725 [95% CI 0.54-0.98]). An expectation of TKA to improve psychological well-being was associated with lower odds of satisfaction for individuals in the lowest tertile of pre-TKA KOOS-PS scores (adjusted OR 0.49 [95% CI 0.28-0.84]), but higher odds for those in the highest tertile (adjusted OR 2.37 [95% CI 1.33-4.21]). In patients with TKA, preoperative expectations regarding kneeling and psychological well-being were significantly associated with the level of TKA satisfaction at 1 year. Ensuring that patients' expectations are achievable may enhance appropriate provision of TKA.

Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty \u2013 results from a German prospective cohort study

BackgroundEvaluation of variations in pre- and postoperative patient reported outcomes (PRO) and the association between preoperative patient characteristics and health and satisfaction outcomes after total knee arthroplasty (TKA) may support shared decision-making in Germany. Since previous research on TKA health outcomes indicated valuation differences in longitudinal data, experienced-based population weights were used for the first time as an external valuation system to measure discrepancies between patient and average population valuation of HRQoL.MethodsBaseline data (n = 203) included sociodemographic and clinical characteristics and PROs, measured by the EQ-5D-3 L and WOMAC. Six-month follow-up data (n = 161) included medical changes since hospital discharge, PROs and satisfaction. A multivariate linear regression analysis was performed to evaluate the relationship between preoperative patient characteristics and PRO scores. Patient acceptable symptom state (PASS) was calculated to provide a satisfaction threshold. Patient-reported health-related quality of life (HRQoL) valuations were compared with average experienced-based population values to detect changes in valuation.ResultsOne hundred thirty-seven subjects met inclusion criteria. All PRO measures improved significantly. Preoperative WOMAC and EQ-5D VAS, housing situation, marital status, age and asthma were found to be predictors of postoperative outcomes. 73% of study participants valued their preoperative HRQoL higher than the general population valuation, indicating response shift. Preoperatively, patient-reported EQ-5D VAS was substantially higher than average experienced-based population values. Postoperatively, this difference declined sharply.Approximately 61% of the patients reported satisfactory postoperative health, being mainly satisfied with results if postoperative WOMAC was ≥82.49 (change ≥20.25) and postoperative EQ-5D VAS was ≥75 (change ≥6).ConclusionOn average, patients benefited from TKA. Preoperative WOMAC and EQ-5D VAS were predictors of postoperative outcomes after TKA. Particularly patients with high absolute preoperative PRO scores were more likely to remain unsatisfied. Therefore, outcome prediction can contribute to shared-decision making. Using general population valuations as a reference, this study underlined a discrepancy between population and patient valuation of HRQoL before, but not after surgery, thus indicating a potential temporary response shift before surgery.

Highly Satisfied Total Knee Arthroplasty Patients Display a Wide Range of Soft Tissue Balance.

Soft tissue balancing while crucial for a successful total knee arthroplasty (TKA) is incompletely defined and the subject of broad recommendations. We analyzed 69 unilateral computer-assisted surgery posterior stabilized (PS) TKA subjects who postoperatively scored ≥36 out of a possible 40 points on the satisfaction section of the American Knee Society score (2011). We examined a range of postoperative coronal plane laxity parameters and the correlation between preoperative and postoperative laxity. Total postoperative coronal laxity arcs at maximum extension and 20 degrees of flexion varied between 2 and 12 and 3 and 13 degrees, respectively. Depending on the position of measurement, medial laxity was between 0.5 and 9.5 degrees and lateral laxity between 1 and 12 degrees. The change in laxity between maximum extension and 90 degrees of flexion demonstrated a range of 7 degrees medially and 12 degrees laterally. The total coronal arc of movement did not affect functional outcomes. A moderate correlation of 0.452 and 0.424 was seen between initial and postoperative total coronal laxity arcs in maximum extension and 20 degrees of flexion, respectively. The individual variability for each measured parameter within our cohort demonstrates TKA satisfaction is not as simple as producing a narrow range of coronal laxity parameters and that as with many body systems considerable variation is still consistent with excellent function. Our findings help to define acceptable balance parameters for PS TKA. It does not appear necessary to closely match postoperative laxity to that present preoperatively.

Total Knee Arthroplasty Communication Checklist Increases Patient Satisfaction

BackgroundSatisfaction with total knee arthroplasty (TKA) is correlated with the fulfillment of expectations. Good surgeon-patient communication impacts how expectations are formed and managed. The TKA communication checklist was developed to help surgeons better understand and manage patients’ postoperative expectations in order to increase satisfaction with TKA. MethodsIn this prospective cohort study, mean satisfaction scores of a standard of care communication group and a checklist intervention group were compared. The duration of postoperative follow-up appointments was also assessed to determine whether the checklist took significantly more time in practice. ResultsSixty patients received the checklist in TKA appointments with surgeons between 6 weeks and 6 months postoperatively and their satisfaction ratings were compared with 67 patients who had received the standard of care communication. The checklist group reported higher satisfaction on overall TKA satisfaction and expectations met (P = .02), care and concern shown by the surgeon (P = .01), surgeons’ communication ability (P = .01), and satisfaction with time spent in follow-ups (P < .001). Satisfaction with relief from pain and return to function was not significant (P = .06). More time was spent in the checklist groups’ follow-ups, with a mean difference of 1 minute, 51 seconds (P = .001). ConclusionThe TKA communication checklist significantly improved patients’ satisfaction across multiple dimensions. This has practical significance because patient satisfaction is increasingly used as a key performance indicator for surgeons and healthcare institutions alike. Increased TKA satisfaction will benefit patients, surgeons, and the healthcare system overall.

Intra-operative Analysis of Different Patellar Implant Designs in Total Knee Replacement: A Prospective Randomised Comparative Trial

Objectives:Present scientific literature supports patellar resurfacing with regards to reduced re-operation risk and improved long term patient satisfaction in total knee arthroplasty (Schindler 2012). Two basic techniques are present for resurfacing the patella (Lachiewicz 2003); onlay and round inset (IN). Onlay designs are either symmetrical (round) (OR) or oval shaped with an asymmetric ridge (OO). When using a round patellar implant, a lateral facetectomy is often performed to avoid lateral compression syndrome and enhance patellar tracking (Zhang, Zhang et al. 2012). However, none of these implants have been found to be superior to the other. This study will compare three different types of patellar implant designs commonly used for resurfacing in TKA and report on intra-operative outcomes. We hypothesise that OO design offers improved bone coverage with less need to perform facetectomy when compared to round designs.Methods:A prospective, randomised trial was performed on patients undergoing unilateral TKA by 2 surgeons. Patients who agreed to participate were allocated to one of the three patellar design groups (IN, OR, OO). Patients were blinded to the implant assigned to them. The prostheses were implanted with the aim to restore pre-resection thickness, uniform facet thickness, with maximal bone coverage and medialisation of the median ridge to enhance tracking. Groups were compared in terms of implant size, percentage bone coverage, lateral facet underhang and requirement for facetectomy. Paired t-tests and ANOVA were used to compare continuous outcome measures with chi-squared test for categorical variables.Results:86 patients were initially assessed for inclusion. Eight patients refused to participate and a further 18 did not meet the study inclusion criteria. A total of 60 patients were included in the final analysis. There were no differences between the 3 groups with regards to mean age, sex, pre-resection patellar thickness, patellar dimensions or pre-operative Kujala score. The asymmetrical onlay design resulted in a statistically significant larger button size (mean size 25.3 mm IN, 32.7 mm OR, 34.6 mm OO; p<0.001), reduced lateral underhang (mean 11.1mmm IN, 7.7 mm OR, 1.2 mm OO; p<0.001), and reduced need for facetectomy (85% IN, 85% OR, 0% OO). Percentage of surface bone coverage was 49%, 63.8%, 89.6% for IN, OR, OO implants respectively (p< 0.001).Conclusion:Oval onlay design demonstrates better surface bone coverage than round onlay or inlay implants. There were no cases in the oval group that required lateral facetectomy. Future analysis of this study group will aim to determine whether radiographic, patellar vascular and functional outcomes vary amongst the designs.

Higher Patient Expectations Predict Higher Patient-Reported Outcomes, But Not Satisfaction, in Total Knee Arthroplasty Patients: A Prospective Multicenter Study

BackgroundThe relationship between patient expectations, patient-reported outcomes (PROs), and satisfaction in total knee arthroplasty (TKA) patients is not well understood. MethodsWe prospectively evaluated patients who underwent primary TKA at 4 institutions. Demographics were collected. Preoperatively, patients completed the Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES), SF-12, UCLA activity, and Knee Disability and Osteoarthritis Score. At 6 months and 1 year postoperatively, patients completed the Hospital for Special Surgery Knee Replacement Fulfillment of Expectations Survey (HSS-KRFES), a satisfaction survey, and PROs. Step-wise multivariate regression models were created. ResultsEighty-three patients were enrolled. At 6 months and 1 year postoperatively, the follow-up rate was 84.3% and 92.7%, respectively. No demographics or preoperative PROs were predictive of HSS-KRES. Preoperative HSS-KRES did not predict postoperative satisfaction, but higher HSS-KRES predicted higher HSS-KRFES at 1 year, greater improvement in UCLA activity at 6 months and 1 year, and SF-12 Physical Composite Scale and Knee Disability and Osteoarthritis Score at 6 months. Higher HSS-KRFES predicted higher satisfaction at 6 months and 1 year. ConclusionIn TKA patients, preoperative expectations are not influenced by patient demographics or preoperative function. Higher preoperative expectations predict greater postoperative improvement in PROs and fulfillment of expectations. These findings highlight the importance of preoperative patient expectations on postoperative outcome.

Meeting patient expectations and ensuring satisfaction in total knee arthroplasty.

Osteoarthritis (OA) of the hips and knees is estimated to be the fourth leading cause of functional disability globally. OA is strongly associated with ageing and the Asian region is indeed aging rapidly. The morbidity burden of OA in Asia is significantly increasing (1). In Asia, there is a greater demand for a pain-free knee joint of good range of motion due to cultural, religious or simply lifestyle reasons. Asians are more likely to squat and kneel for prolonged periods of time. Prolonged squatting has been suggested to account for a significant variation in prevalence of knee OA between Chinese subjects from Beijing, China and White subjects participating in the Framingham OA study (2). Total knee arthroplasty (TKA) has been thought to be the definitive solution for chronic mechanical knee pain secondary to OA. the definitive solution for chronic mechanical knee pain secondary to OA. The number of TKAs performed has been increasing steadily over the years according to the national registry in Seoul, Korea (3), as with the rest of the Asia-Pacific region. However, patients’ expectations of TKA outcomes seem to differ from the measured outcomes of the surgery (4). Most expected patient-reported outcomes were improvement in pain, restoration of function and resolution of need for assistive devices. There is a significant difference between actual and expected activities after TKA for OA. While TKA relieves pain and restores function beyond doubt, several studies have showed that only 82- 89% of patients expressed satisfaction after their primary total knee replacement (5-12). Patient satisfaction is fast becoming an important tool for assessing outcome of TKA (13). However, patient satisfaction is a complex phenomenon that is affected by many elements that determine health-related quality of life (14). This is influenced by the patient’s cultural, social and psychological make as well. It is well known that many cultural practices in Asia requires the patient to kneel and/or squat and the ability to achieve this post-TKA will undoubtedly have some impact of patient satisfaction scores. Good clinical and functional outcome as determined by clinicians does not always equate to patient satisfaction as the difference between patients’ and clinicians’ perception of good outcomes is well known (15). This has led to the development and validation of patient-reported outcome measures (PROMs) or otherwise known as patient satisfaction scores in orthopaedic surgery. While there are numerous tools to measure patient satisfaction after these procedures, it is the long-term satisfaction that is the most important goal of surgery in patients with OA (11). This editorial will evaluate patient satisfaction following TKA as well as the factors that have a profound influence on satisfaction.